A Place For Mom: The Best-Kept Secret in Long-Term Care
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A middle-aged woman tiptoes out of your elderly patient's room as you stand at the computer making your latest entry, then sneaks a look back to make sure her mother is still sleeping. Shyly, she... Read More

And why is this article called "the best kept secret"? The best kept secret is that a person may go into assisted living and be fine for a year but then they need more care and that increases the cost by a huge amount. Paying $400/mo for my dad to be given his 4-5 pills/day (and he paid for the meds) is outrageous. Some assisted living places charge by the pill. One told me it was $5/pill and that included tylenol, etc. And that was a few years ago so maybe it is now $6/pill. The fact of the matter is is that the U.S. is not a good place to be when one becomes old or ill.

My mom lived in assisted living for the last 15 years of her life. She lived in two different facilities and each had it's good points. Both were lovely and the people who worked there did all they could to help mom be healthy and happy.

The first provided all the care she needed as someone who wanted to maintain as much independence as possible. She got her meals, help with bathing if needed, and her medications dispensed by a nurse. There was a doctor who could be called if needed, and she checked in on people of the nursing staff thought it was needed. Mom's room was a big one where she had her bed on one side and living room furniture on the other. She had her own bath but the shower and tub were down the hallway, so not as private as she would have liked. She didn't have a fridge or a microwave, and couldn't have gotten one or been given one by family. Meals were provided in a big dining room. This facility seemed more like a nursing home outside mom's room than the second place.

The second facility had a lovely large room with a divider between living and sleeping spaces, and a private bath with a shower that could have been used by someone with a wheelchair. It had a kitchenette. The group dining room was beautiful. There was a library and a computer room. There was a big kitchen people could use to cook for their families on special occasions. There were "family" rooms here and there for when the number of visitors was too big for her own room to accomodate. The drawback of this place was there was no nursing staff on duty, ever. There were aides present, but they weren't allowed to do anything remotely medical. They did laundry and cleaned rooms. They were around alot and very very nice to my mom. They could remind people about medications but couldn't open bottles or hand the bottles or medications to people. If someone fell, they couldn't help him or her up. An ambulance had to be called if the person couldn't get up on his/her own.

I think it's obvious that anyone would rather live in a ALF over a SNF. It's more like having your own apartment with frequent caregiver, while a SNF is more "institutional". But they are just so expensive. Only the super rich can afford to live in one for any great length of time. It just seems like a why to drain all the money out of the elderly for a couple years (at most) before they go to a LTC to live out the remainder of their lives. I'm sorry if this sounds harsh, but it just seems like an ultra expensive long vacation or something before they finally go to the LTC they were destined for all along....

We do everything possible to allow our residents to "age in place", that is to say, we don't kick them out if they go on Medicaid or become a two-person transfer. We also try to keep them even if they go on hospice and would otherwise need more care than we can provide. And as far as costs go, the $4000+/month our highest acuity resident pays is only about two-thirds of what it would cost him to live in a nursing home, which is where he actually belongs (but that's a story for another day).

Most of our residents die in our facility after an average stay of 4 1/2 years. That's pretty good statistically, considering the national average is somewhere around 2 years. Yes, some companies are all about profits, and yes, some facilities are very poor in quality; however, the same can be said for every level of care.

I think it's obvious that anyone would rather live in a ALF over a SNF. It's more like having your own apartment with frequent caregiver, while a SNF is more "institutional". But they are just so expensive. Only the super rich can afford to live in one for any great length of time. It just seems like a why to drain all the money out of the elderly for a couple years (at most) before they go to a LTC to live out the remainder of their lives. I'm sorry if this sounds harsh, but it just seems like an ultra expensive long vacation or something before they finally go to the LTC they were destined for all along....

I'm not sure where you live, but the lovely ALF where my mother stayed was about $1200/month, and most of it was covered by Medicare. My mother had minimal savings, but my sister (the POA) figured she'd have enough to stay there for 7 years before the money ran out. Unfortunately, my mother's dementia progressed beyond their level of care after about 2 and a half years. I'm very grateful for the 2 and a half years Mom was able to stay there. It was a lovely place, and the staff were all very good to my mother and to our family.

I admit, I've never worked in assisted living and I've never had a family member in one, so my knowledge is based on anecdotal evidence. I was under the impression a fairly independent resident paid about $3200 a month. But again, that's just anecdotal. I've only worked in nursing homes, so maybe Im biased.

When I was a little kid, old people went straight to a nursing home where they lived out the rest of their lives. Assisted living just seems like an artificial level of care tacked on before skilled nursing.

But then again, I also thought all ALF were 100% private pay, so I guess I should do some research. I'm sincerely glad for anyone whose family found a happinessin assisted living. And I totally understand the appeal of aging in place and with dignity. No disrespect intended.

As a staff nurse in a small community hospital, I have cared for many residents of ALF while in the hospital.Some do well, others have no idea of who they are or why they are any where. I would be afraid to leave my loved in a place with minimal staff at night- what about fire? I have talked with several people who have worked in AFL and they were the only staff member present at night. How could 1 person make sure 30 or more folks were safe in an emergency. About 10 yrs ago when my daughter was 16, she got a job working at ALF. Her first day there she set the table for dinner, cleaned toilets and then gave the residents their meds. When she came home and told me that she had given people meds, I almost had a stroke. She wasn't happy, but she did not keep her job. As a RN and mom,I did not feel comfortable with my teenage child giving meds. I guess you just have to check out the individual ALF and go into it with your eyes and ears wide open!

It's true, the quality of ALFs varies greatly by location, company, and numerous other factors. In my next article in this series, I'll discuss staffing models such as the "neighborhood" concept, nurse delegation and the duties of the RN, and training requirements for the unlicensed assistive personnel who perform the vast majority of the care and housekeeping tasks for their assigned residents.

There are so many different types of ALF's that exist,...Here in FL they are becoming more strict on the regulation of what these facilities can and can't do. All med tech's must have a certification course before passing meds. There are also varying licenses the facility can hold to allow them to perform skilled nursing tasks as well. Many ALFs in my area do not have an RN on staff, only LPNs and CNAs. There are also special criteria the pt must meet for admission (like being able to stand/pivot or no stage 3 decubs).

Also, there's so many different scenarios-good and bad. Some places are family owned and others are large campuses with various departments inside (ALF, LTC, and independent living). For many families, there is a great deal of limbo regarding the proper placement for their parents. Its a huge and very expensive decision to choose and ALF and many cannot afford it (or run out of money trying to). I do know that certain facilities accept a Medicare Waiver, I am not sure what this entails but I have heard that this cuts some costs. Many ALFs in my area charge a monthly price that includes 3 meals, housekeeping/laundry, transportation to appts/errands, and activities. Although the amenities vary from place to place, they may include toiletries and incontinence supplies or may include medication management in their price-some charge a monthly fee. For so many families who employ around the clock private duty aides, ALFs are a heaven sent-bc at the end of the day, they still need to cook/clean/arrange appts etc.... What I notice is the huge need for the facilities that have Dementia Care. At my facility, we are at capacity in our dementia wing-it is so hard to find places for exit-seekers. It is really amazing to see the growth and popularity of ALFs come to the forefront. It should be made to be more affordable because so many people are in need of this "in-between" type of healthcare.....